Organization
FIRST CHOICE MEDICAL GROUP OF BREVARD LLC
Active
Other names
First Choice Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
PHILLIP KELLER (CFO)
(321) 725-0090
Entity
Organization
Contact information
Practice address
650 S COURTENAY PKWY STE 100, MERRITT ISLAND, FL 32952-4977
(321) 725-2225
(321) 308-0635
Mailing address
709 S HARBOR CITY BLVD, SUITE 100, MELBOURNE, FL 32901-1938
(321) 725-2225
(321) 308-0635
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
—
—
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002JP
FLORIDA BLUE
FL
Enumeration date
09/26/2011
Last updated
12/01/2020
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